National Provider Identifier [NPI]: |
1841209111 |
Last Name Of The Provider |
ANTOLAK |
First Name Of The Provider |
CHRISTOPHER |
Middle Initial Of The Provider |
M |
Credentials Of The Provider |
MD |
Gender Of The Provider |
M |
Entity Type Of The Provider |
I |
Street Address 1 Of The Provider |
2600 39TH AVE NE |
Street Address 2 Of The Provider |
|
City Of The Provider |
MINNEAPOLIS |
Zip Code Of The Provider |
554214379 |
State Code Of The Provider |
MN |
Country Code Of The Provider |
US |
Provider Type Of The Provider |
Family Practice |
Medicare Participation Indicator |
Y |
Number Of HCPCS |
78 |
Number Of Services |
1129 |
Number Of Medicare Beneficiaries |
177 |
Total Submitted Charge Amount |
137545 |
Total Medicare Allowed Amount |
51167.46 |
Total Medicare Payment Amount |
36998.18 |
Total Medicare Standardized Payment Amount |
38012.58 |
Drug Suppress Indicator |
|
Number Of HCPCS Associated With Drug Services |
7 |
Number Of Drug Services |
68 |
Number Of Medicare Beneficiaries With Drug Services |
52 |
Total Drug Submitted ChargeAmount |
2197 |
Total Drug Medicare AllowedAmount |
1494.2 |
Total Drug Medicare PaymentAmount |
1448.4 |
Total Drug Medicare Standardized Payment Amount |
1448.4 |
Medical SuppressIndicator |
|
Number Of HCPCS Associated With MedicalServices |
71 |
Number Of Medical Services |
1061 |
Number Of Medicare Beneficiaries With Medical Services |
177 |
Total Medical Submitted Charge Amount |
135348 |
Total Medical Medicare Allowed Amount |
49673.26 |
Total Medical Medicare Payment Amount |
35549.78 |
Total Medical Medicare Standardized Payment Amount |
36564.18 |
Average Age Of Beneficiaries |
73 |
Number Of Beneficiaries Age Less65 |
31 |
Number Of Beneficiaries Age 65 to 74 |
55 |
Number Of Beneficiaries Age 75 to 84 |
51 |
Number Of Beneficiaries Age Greater 84 |
40 |
Number Of Female Beneficiaries |
79 |
Number Of Male Beneficiaries |
98 |
Number Of Non Hispanic White Beneficiaries |
|
Number Of Black or African American Beneficiaries |
|
Number Of AsianPacific Islander Beneficiaries |
|
Number Of Hispanic Beneficiaries |
|
Number Of American Indian Alaska Native Beneficiaries |
|
Number Of Beneficiaries With Race Not Else where Classified |
|
Number Of Beneficiaries With Medicare Only Entitlement |
152 |
Number Of Beneficiaries With Medicare Medicaid Entitlement |
25 |
Percent Of With Atrial Fibrillation |
11 |
Percent Of With Alzheimers Disease or Dementia |
6 |
Percent Of With Asthma |
|
Percent Of With Cancer |
8 |
Percent Of With Heart Failure |
15 |
Percent Of With Chronic Kidney Disease |
26 |
Percent Of With Chronic Obstructive Pulmonary Disease |
9 |
Percent Of With Depression |
19 |
Percent Of With Diabetes |
26 |
Percent Of With Hyperlipidemia |
35 |
Percent Of With Hypertension |
58 |
Percent Of With Ischemic Heart Disease |
29 |
Percent Of With Osteoporosis |
6 |
Percent Of With Rheumatoid Arthritis Osteoarthritis |
26 |
Percent Of With Schizophrenia Other PsychoticDisorders |
|
Percent Of With Stroke |
|
Average HCC Risk Score Of Beneficiaries |
1.2408 |